HEALTH MATTERS Prevention key for women's wellness concerns

March 04--Aggressive screening campaigns have reduced U.S. death rates for both cervical and breast cancer over recent decades.

The success in women's health illustrates the core of a preventive approach to medicine known as population health.

Dr. Marquita Decker-Palmer, associate director of the 1889 Jefferson Center for Population Health in Johns-town, called method "an approach to health and wellness -- not just on an individual level -- but thinking about it on a regional level.

"We are going at the source," Decker-Palmer said.

"That's what screenings are about."

Cervical cancer

Cervical cancer is one of population health's most resounding successes, when it comes to women's concerns. Incidence of cervical cancer in the United States decreased from 14.8 cases for every 100,000 women in 1975 to 6.5 cases per 100,000 in 2012.

The improvement is credited to a test, commonly known as the Pap smear, developed by George Papanicolaou and introduced in the 1950s. Originally, prevention treatment involved major surgery, but less invasive treatments now allow doctors to remove lesions before they become tumors.

"We are fortunate that we have these types of screenings," Decker-Palmer said. "That's the whole goal of pop health -- prevention."

New advances in the past 10 years include a vaccine to prevent women from contracting sexually transmitted human papillomavirus, which is known to cause many cervical cancers.

"It can be given as early as 9 years old, and it has been studied up to 26 years," said Natalie Kukucka, a certified nurse midwife with Conemaugh Physicians Group -- OB/GYN, 600 Aberdeen Drive in Somerset.

"We try to give the vaccine before they become sexually active," Kukucka continued. "We are trying to prevent the disease. It is not going to cure it."

Pap tests for cervical cancer and yearly mammograms for breast cancer are among the most recognized women's health screenings, there are dozens of measures women should follow for better health, experts say.

STDs, HIV, AIDS

Working on the front lines of public health, Highlands Health free medical clinic in Johnstown has ramped up efforts to screen for sexually transmitted diseases, including HIV and hepatitis C.

Staff from Highlands Health, formerly Johnstown Free Medical Clinic, recently held two screening events at Lucy's Place, 520 Washington St.

"It's like taking it to where the vulnerable population is found," Executive Director Rosalie Danchanko said at the clinic, 320 Main St. "We thought we'd be run out of the place, but 15 people lined up the first night."

Although HIV and AIDS first became epidemic among white males, the demographics have shifted, Decker-Palmer said.

"Now it is largely women who are getting it," she said.

Baby boomers have been found to be at higher risk for hepatitis C, in part because there was no test for the strain of virus in 1970s and 1980s. There was also more unprotected sex in the pre-AIDS era, Decker-Palmer said.

"One of the reasons is blood transfusions," she said.

"Before about the 1980s, donated blood was screened differently than it is now. Back then, there was a one chance in half a million of getting hepatitis (from a transfusion). Now it's one in several million."

The annual checkup at the gynecologist's office should include STD screening, Kukucka said.

"Any woman who is sexually active is qualified to get the screening," Kukucka said.

"Anytime you have a change in sexual partners you should be tested."

Women should feel comfortable discussing their sexual activity with their care providers, Kukucka said.

"Nothing can make us blush," she said. "This is our job. It's your safe zone. You can talk about anything. I tell them: I'm not your grandmother."

Routine screenings by primary care doctors are not so routine for those using the free clinic, Danchanko said.

"The population we serve is doesn't think about screenings and immunization because they are more in the present -- the now," Danchanko said. "They are thinking: How am I going to get food on the table?"

That's why Highland Health leaders are reaching out to those who can't afford a primary care doctor.

Diabetes, heart diseasePreventing diabetes and heart disease in women are two areas of focus, Highland Health Medical Director Dr. Loretta Opila said.

"Some of the most challenging patients we have are the ones who have had diabetes for years and years, and now they have no toes," Opila said, recalling two recent patients.

Annual blood tests and blood pressure screenings can help women control some of the risk factors, but population health advocates also want physicians to encourage more preventive lifestyle changes.

"One of the things you can do is modification of lifestyle," Karen Menser, certified nurse practitioner, said at the Conemaugh OB/GYN office in Somerset. "The American Heart Association recommends at least 150 minutes of moderate exercise a week."

Not using tobacco and controlling body weight are also important, Menser said.

"Women don't always think of themselves as at risk for heart disease," Opila said. "But it's the No. 1 killer of women in the country."

While men are more likely to experience the classic stabbing chest pain and pressure, heart attack symptoms are often different for women, she added.

"Some of the more common symptoms are fatigue and tightness in the chest," she said.

Women may feel the pain in the back or jaw, Decker-Palmer said.

Depression and anxiety

With many illnesses, including heart disease, women often overlook their own symptoms because they are focused on caring for children and their families, Michelle George, community project manager, said at the population health center.

"I think things are changing now," George said.

"Now women are going into the emergency room. Before they would pass it off as stress and anxiety."

Mental health screenings are an important part of every woman's annual checkup, Kukucka said.

Both primary care doctors and gynecologists are among those who routinely screen for depression and anxiety.

"We assess that, particularly postpartum," Kukucka said, noting that the birth of a child creates major changes in the mother's body chemistry, as well as her lifestyle.

"During the first seven to 10 days after the baby is born, it's normal not to feel like yourself," she said. "But if within the first year, if you feel like you don't want to take care of yourself; take care of your baby; take care of the house; or have mood swings -- these can be some warning signs.

"Come in and see us for a screening.

"Based on that, we can talk about different interventions that would fit with that patient and her philosophy."

Randy Griffith is a multimedia reporter for The Tribune-Democrat. He can be reached at 532-5057. Follow him on Twitter @PhotoGriffer57.

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